Friday, October 30, 2009

I wrote last week about Terry Bazzani, a man with no hands and other physical problems, who was caught on what he said was his first trip as a drug mule. The Crown wanted a penitentiary term. The defense argued the punishment would be far to severe for Bazzani, who can't feed or clean himself, brush is teeth or, of course, defend himself.The case, I maintained. showed the foolishness of mandatory minimum sentences, which many politicians want for such crimes. Justice Keith Bracken this week rejected the Crown prosecutor's argument. Bazzani will serve a two-year sentence under house arrest, with relaxed conditions.

It doesn't matter what the intentions are. The Campbell government's actions are resulting in a shift to two-tier health care in B.C.People who can pay get fast, effective treatment. The rest of British Columbians wait, suffer and get sicker.Earlier this month, the Vancouver Island Health Authority said provincial funding was inadequate to maintain health care services. It chopped surgeries and support for seniors and people with mental illness.For example, last year the health authority did 124 bariatric surgeries. The operations help obese people who have been unable to lose weight in less extreme ways. Their stomachs are made smaller or bowels shortened to reduce the absorption of calories the number of bariatric surgeries.It's not easy to get on the list for the surgery, which is expensive and, of course, carries risks. Patients who receive referrals have tried other ways of losing weight and face serious health complications from obesity. Tough luck, some would say. Try harder or suffer.That ignores the reality of their illnesses. And it ignores the great costs that the system would face in coming years if they remain obese. Pragmatically, effective treatment is a good investment.Last year, the health authority performed 124 of the procedures in Victoria. This year, it will cut the number to 80. Next year, it will reduce the number of surgeries to 52.Demand hasn't fallen. The wait for treatment is measured in years. But the health authority's provincial funding for this year falls $45 million short of what is needed to provide health care services. The gap will be greater next year.So patients won't be treated.Unless they have money.The False Creek Surgical Centre, a private clinic in Vancouver, has been advertising an information centre in Victoria next weekend on its weight loss surgery. People can register for a presentation with light snacks and a chance to have questions answered. A similar session is planned for Kelowna later in the month.It's a good business move. There are desperate people who have waited several years for surgery who now face an even longer wait. The surgical centre can offer them speedy, effective treatment.Or the centre can if they have about $17,000 to cover the costs of lap band surgery and follow-up. The procedure involves placing an inflatable ring around the upper stomach, limiting the amount of food the person can eat and increasing the length of time to digest the food.Bravo, say some people. If I can pay extra to jump the queue for other things, for higher quality treatment, why not for health care?But so far Canadians have decided that health care is different. We have, after a fierce public discussion, decided that when care is rationed, it shouldn't be auctioned off the to the highest bidder. If two people have an illness, then the decision on who gets treatment is to be based on medical need.We've even written the principle into law. The Canada Health Act and B.C.'s Medicare Protection Act say people cannot pay extra for speedier treatment for any medically necessary procedure.But the law is routinely ignored. Private clinics have pushed the boundaries in offering more and more surgery to those who can pay for faster treatment.You can't argue credibly that the weight-loss surgery isn't medically necessary. For starters, the diagnosis of medical need has already been accepted by the health-care system, at least for people on the wait list.The False Creek Surgical Centre emphasizes the point. Obesity is not the result of a lack of willpower; "It's a disease that requires treatment."And the centre also points out that the surgery can reduce patients' risk of diabetes, heart disease, stroke, cancer and other serious conditions.I certainly don't fault people who decide to pay for the surgery. I probably would.But the combination of surgical cutbacks and inaction on the expanding role of private clinics is taking us a long way from the principles of medicare - and the laws that set them out.Footnote: The issue might end up being resolved in the courts. Four private clinics are challenging the government's ability to enforce the Medicare Protection Act. And a group of patients are suing to require the government to enforce the act.

Tuesday, October 27, 2009

Can B.C. taxpayers really can afford $458 million for a fancy new roof on B.C. Place?Especially right now. The government has chopped funding to fix leaky schools. Health authorities are cancelling thousands of surgeries to save money. School parents' groups, people who work with seniors, mental health programs - the government says there is no money to keep on supporting them. Youth sport funding has been chopped.But for a Vancouver stadium and its two main pro sports teams, the government can find almost $500 million from taxpayers.Which works out to about $106 per British Columbian - say $425 for a family of four. If they live in Prince George or Nelson, it's a big bill for a stadium they will likely only see on TV.The government justifies the project on two grounds. Tourism Minister Kevin Krueger said the project will create 3,000 per years of employment. But that's a cost of more than $150,000 for each one-year job. The government could create the same employment at much lower cost simply by reversing cuts that have meant layoffs across the province.And Krueger says a retractable roof will result in greater use of B.C. Place and indirect economic benefits for Vancouver.You own the stadium. It's operated by a Crown corporation, Pavco, which also runs the Vancouver Convention Centre. Pavco's last annual report said the stadium was booked for about 200 events last year. The average economic impact was about $300,000 per event, Pavco estimates.With the roof, the Crown corporation hopes that by 2013 there will be an extra 41 bookings a year, more than one-third of them from the Vancouver Whitecaps soccer team. And it expects each of those to generate an extra $1 million in spinoff benefits.The corporation, and thus the government, is counting on attracting bigger summer events once the roof can open. (It's too often hot and uncomfortable now, apparently.)There's certainly a chance for greater economic benefits if the right events can be added to the schedule. U2 played in GM Place this week; of the 56,000 tickets, 16,000 were sold to people from outside the province. That's a lot of hotel rooms that will be booked and restaurant meals.But it's also true that there is no guarantee that will happen.And people outside Vancouver - or even outside the business sectors that will benefit - have a right to wonder why they are footing the bill for a reno that benefits a couple of sports teams and a specific group of businesses.You are paying. The government has been a little cute in announcing the project, describing its commitment as a loan to Pavco. That's not really accurate. The Crown corporation is going to use $42 million left over from the Vancouver conference centre project. (Which, you'll recall, ended up costing $841 million, although Premier Gordon Campbell had insisted the $495-million budget was adequate. Provincial taxpayers picked up the whole bill for the overruns.)And it hopes to raise the rest of the money by leasing land taxpayers own around the stadium site for development. If that works, it can repay the loan.But that's still a cost to taxpayers. The people of B.C. own that land. It could be developed and the money used for health care or tax reductions or to reverse cuts in services in smaller communities.There are other ways of funding the roof, if it is a good investment. In other places, special taxes or fees have helped ensure that the people and businesses who benefit from the stadium improvements pay the costs. There could be a tax on Lower Mainland hotel rooms earmarked for the new roof, or a surcharge on event tickets or a levy on Vancouver businesses. If the benefits are as claimed, that would be fair - certainly fairer than asking someone in Penticton to pay for Vancouver's fancy new stadium roof.Footnote: Don't expect much political debate on this. The NDP supports the new roof, although MLA Spencer Herbert notes the cost estimate has more than doubled in the last 12 months. Politicians do seem to love fancy stadiums for sports teams.

Monday, October 26, 2009

For those settling down for an evening of Monday Night Football, recommended half-time reading could be found here at the New Yorker. Alarmingly clever - and Canadian - writer Malcolm Gladwell looks at brain injuries suffered by NFL players and wonders how the league differs from the dog fighting that got Michael Vick in such trouble.